Thursday, December 15, 2011

Leadership and Service Interest

For Boards/ Commissions/Committees/Councils/Agencies/Institutions of the Eastern Pennsylvania Conference of The United Methodist Church

Please complete this form to indicate your interest in serving within the Eastern Pennsylvania Conference no later than February 1, 2012.

First Name: *

Last Name: *

Mailing Address: *

City: *

State: *

Zip Code: *

Daytime Phone Number: *

Evening Phone Number: *

Email Address:

Church Name: *

Years at this church: *

Age (Optional):

Gender (Optional):

Disability Status (Optional):

Race/Ethnicity (Optional):

Leadership Roles:

Please list any leadership roles you have served at the local church, district or conference level and for how long.

Employment Experience and Educational Training:

Please outline any employment experience and/or educational training you have that applies to interest area(s).

Gifts and Passions:

Please list any gifts and/or passions related to your interest areas.

Certification of Interest: *

Yes

By selecting "Yes" you certify that, if elected, you will attend the meetings and actively participate in the work of the group(s), and have no known conflicts of interest that could interfere with your service on the group(s).

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